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Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study.
- Source :
-
European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2017 Apr; Vol. 6 (3), pp. 232-243. Date of Electronic Publication: 2016 Jan 19. - Publication Year :
- 2017
-
Abstract
- Background: Fibrinolytic therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention.<br />Methods: Using a sequential cross-sectional study with two-stage random sampling in 2001, 2006, and 2011, we characterised the use, timing, type and dose of fibrinolytic therapy in a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to hospitals without the ability to perform percutaneous coronary intervention.<br />Results: We identified 5306 patients; 2812 (53.0%) were admitted within 12 hours of symptom onset, of whom 2463 (87.6%) were ideal candidates for fibrinolytic therapy. The weighted proportion of ideal candidates receiving fibrinolytic therapy was 45.8% in 2001, 50.0% in 2006, and 53.0% in 2011 ( P <subscript>trend</subscript> =0.0042). There were no regional differences in fibrinolytic therapy use. Almost all ideal patients (95.1%) were treated after admission to the hospital rather than in the emergency department. Median admission to needle time was 35 minutes (interquartile range 10-82) in 2011, which did not improve from 2006. Underdosing was common. Urokinase, with little evidence of efficacy, was used in 90.2% of patients.<br />Conclusions: Over the past decade in China, the potential benefits of fibrinolytic therapy were compromised by underuse, patient and hospital delays, underdosing and the predominant use of urokinase, an agent for which there is little clinical evidence. There are ample opportunities for improvement.
- Subjects :
- Aged
Aged, 80 and over
China
Cross-Sectional Studies
Female
Fibrinolytic Agents therapeutic use
Humans
Male
Middle Aged
Patient Admission statistics & numerical data
Retrospective Studies
Time-to-Treatment
Treatment Outcome
Fibrinolytic Agents administration & dosage
Percutaneous Coronary Intervention statistics & numerical data
ST Elevation Myocardial Infarction drug therapy
Thrombolytic Therapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 2048-8734
- Volume :
- 6
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- European heart journal. Acute cardiovascular care
- Publication Type :
- Academic Journal
- Accession number :
- 26787648
- Full Text :
- https://doi.org/10.1177/2048872615626656